Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Social Perception About Birth as a Demographic Phenomenon

Birth has become a phenomenon of increasing concern. The population of Romania has decreased and is constantly decreasing, the downward evolution is not surprising, all the information on the natural and migratory movement after 1989 define a well-installed demographic decline. Romania's demographic decline is gaining new dimensions and amplifying the deterioration of the country's demographic situation. What is less known and evaluated at the true value is the depth of the deterioration of the age structure of the population in the context of the demographic decline and the implications of this deterioration from the perspective of the possible recovery of the demographic state of the country. The present demographic evolutions, respectively the characteristics of the components that have produced and are still producing these evolutions, foreshadow a strongly negative image regarding the population of Romania in the next decades, if by public policies the birth ratio will not be stimulated

Covid-19 Crisis in Romania - Between Perception and Attitude

The 2019–2020 coronavirus pandemic, also known as Covid-19, debuted on December 12, 2019 in downtown Wuhan, China, when a group of people with pneumonia of unknown cause appeared, was mainly linked by the owners of stalls working on the Huanan fish market, who also sold live animals. The virus presents evidence of person-to-person transmission, and the transmission rate (infection rate) appears to have escalated by mid-January. As measures to prevent the spread of the virus, Romania has adapted a strategy to prevent and control this situation, such as: cancellation or closure of air flights, cancellation of residential meetings, closure of large stores, mandatory self – quarantine of infected persons. Thus, institutions and factories were closed, with the exception of the vital institutions, the closure of churches, educational institutions, universities, sports halls. Awareness campaigns have been launched through the media and social media, the use of disinfectant materials to clean the hands, the use of protective masks and medical gloves, the sanitizing of neighborhoods and roads with cleaning materials. The objective of the study was to determine the effects of the new Coronavirus (COVID19) on the population, both in perception and in attitude. The sample consists of 244 persons and the data obtained after the application of the questionnaire were statistically processed, obtaining the following conclusions: most of the respondents consider that the information received about Covid-19 is correct, a smaller percentage believe that the news about the new Coronavirus are exaggerated; At the same time, the respondents affirm that they will respect all the measures that the Government imposes on them: they will stay at home, they will go out only to buy the necessary products, they will wear masks, gloves, they will wash their hands often. Moreover, most respondents believe that both the country's economy and their personal economy will have to suffer greatly during this period of crisis

Stress and Obligativity of Police Officers

In the present study, I examined the differences between criminal police officers and border police officers. The study&nbsp; shows if there are any semnificative differences of stress and mentality for the two types of policemen. 2 tests were applied on 60 participants, 30 of each category. One test was for measuring stress and the other one for observing the mentality of the employees. The study has 2 hypotheses: the presumtion that there are semnificative differences of stress between the two types of officers and the presumtion that there are semnificative differences between levels of obligativity for the two types of officers. The hypotheses were confirmed. &nbsp

The Influence of the Educational and Family Environment on the Preschool

Johann Wolfgang von Goethe says behavior is "the mirror in which each reflects his image." This is also visible to preschoolers who through their innocence and sincerity exhibit behavioral differences in the family and in the educational institution. The creativity and imagination of the children goes beyond the imaginary lines of reason and the physical contour of this drawing, having a story behind the visible stories of the craft that it carries out